Healthcare Provider Details

I. General information

NPI: 1245425289
Provider Name (Legal Business Name): CLIFTON ETIENNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 PECOS ST UNIT #500
WESTMINSTER CO
80234-3888
US

IV. Provider business mailing address

12201 PECOS ST SUITE 500
WESTMINSTER CO
80234-3888
US

V. Phone/Fax

Practice location:
  • Phone: 303-457-4497
  • Fax: 303-254-4369
Mailing address:
  • Phone: 303-457-4497
  • Fax: 303-540-4692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45991
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: